Brucella peritonitis

We report the case of a patient with peritonitis caused by Brucella melitensis who also had chronic liver disease. At first the patient was treated for bacterial peritonitis but when a lymphocytic ascites was aspirated antituberculosis chemotherapy was given. However, the serological tests for brucellosis were strongly positive and subsequently B. melitensis was isolated from ascitic fluid.

Successful therapeutic regimens for treating Brucella melitensis and Brucella abortus infections in cows

Three therapeutic regimens were evaluated in 121 cows naturally infected with Brucella melitensis or Brucella abortus, using a combination of long-acting oxytetracycline (LA-OTC), streptomycin (ST) and OTC-intramammary infusion (IMI). Cessation of shedding of Brucella in udder secretions and absence of Brucella in selected tissues were considered criteria for successful treatment. Regimen A (tested on 35 cows) consisted of LA-OTC 25 mg/kg administered intramuscularly (i.m.) every 3 days for 42 days, ST 25 mg/kg i.m. daily for 8 days, and OTC-IMI 20 ml/teat daily for 4 days. Regimen B (tested on 53 cows) was similar to regimen A, except that ST was administered every 2 days for 16 days and OTC-IMI every 2 days for 8 days. Both regimens were equally effective in eliminating Brucella organisms from all cows involved in the tests and no relapses were recorded. However, regimen C, which was similar to regimen A, except that ST was administered every 3 days for 24 days and OTC-IMI every 3 days for 12 days, resulted in the elimination of Brucella organisms from only 30 (91%) of 33 cows. Before commencement of the therapeutic regimens, B. melitensis biovar 1 or 2 had been repeatedly isolated from udder secretions of 103 cows and B. abortus biovar 1 from mammary secretions of 18 cows.

Brucellar sacroiliitis: findings in 63 episodes and current relevance

Between 1974 and 1989 we prospectively observed 530 patients with brucellosis. The findings for 62 patients (42 males and 20 females; mean age, 34.7 years) with 63 episodes in which the sacroiliac joint was involved (the most frequent osteoarticular location [11.7%]) were analyzed. Ten of the older patients (mean age, 55.3 years) had concomitant spondylitis. Systemic symptoms were usually important, and characteristic pain and findings of sacroiliitis were observed in approximately 75% of cases. Blood cultures were positive for Brucella melitensis for 44 patients. The most frequent radiographic findings were blurring of articular margins (42 cases) and widening of the sacroiliac space (20 cases). No radiographic anomalies were detected in 13 cases. Results of 99mTc and gallium-67 bone scans were abnormal in approximately 90% of cases (abnormalities were often mild). Overall, clinical, radiographic, and isotopic bone scan findings were sensitive and useful, although they were occasionally minimal or difficult to evaluate, making diagnostic findings confusing or misleading. Brucellar sacroiliitis is a mild disease associated with a good outcome similar to that observed for patients with uncomplicated brucellosis.

Prevalence of camel brucellosis in Libya

Sera of 967 camels of both sexes were tested for antibodies to Brucella using the Rose Bengal plate test, serum agglutination test and the complement fixation test. The prevalence of positive sera was 4.1 per cent. Samples collected for cultural examination revealed 9 isolates. Five isolates were from milk samples, 3 from aborted foetuses and one from a vaginal swab. All isolates were identified and biotyped as Brucella melitensis biovar 1.

Brucellosis among hospital employees in Saudi Arabia

OBJECTIVE

To report experience with brucellosis among expatriate hospital employees in an area of the world where brucellosis is endemic.

DESIGN

Review of cases from the viewpoints of direct supervisor and treating physician, including epidemiologic interviews and clinical follow-up.

SETTING

Tertiary care hospital center in a developing country that increased from 125 beds to 450 beds during the period studied.

PATIENTS

Employees with clinical findings suggesting brucellosis and in whom a positive blood culture or significantly elevated serologic test confirmed the diagnosis.

RESULTS

Nine hospital employees from nonendemic areas developed brucellosis. Five were from England and four from North America. Seven were bacteriology technologists, one was a nurse, and one was an obstetrician. Each had an acute febrile illness with malaise, arthralgia, or headache. Brucella titers were > or = 1:1,280. Five were bacteremic with positive Brucella cultures. All responded to anti-Brucella therapy. Three patients had relapses, but there were no complications.

CONCLUSIONS

Among Saudi patients, brucellosis is generally attributable to drinking infected milk or contacting infected animals. On the other hand, among expatriate hospital employees, the infection is likely due to processing Brucella cultures or dealing with infected body fluids. In 1988, the laboratory began stricter infection control measures. Since then, there has been only one case of brucellosis among the hospital employees.

[Endocarditis caused by Brucella melitensis on a mitral valve prosthesis presenting as an ischemic cerebrovascular accident]

A new case of endocarditis by Brucella melitensis on a mitral valve prosthesis in a 15 year old patient, whose first manifestation was an ischemic cerebrovascular accident is reported. The patient presented with daily fever only two months later. Medical treatment alone was not sufficient to avoid valvular failure and substitution of the prosthesis was required. The clinical manifestations and complications of this infrequent condition is discussed. Treatment, which often requires the combination of surgery and antibiotics administered over a prolonged period, is highly recommended.

Serological and bacteriological study of brucellosis in camels in central Saudi Arabia

Sera from 2,630 apparently normal adult camels (Camelus dromedarius) raised in central Saudi Arabia (Riyadh and Al-Kharj cities) were examined serologically by the Rose Bengal and standard United States of America Brucella plate agglutination tests. The overall seroprevalence of brucellosis in the restricted populations of tested camels was 8%. The seroprevalence of brucellosis among camels raised in small numbers in the backyards of 24 houses in Riyadh and those intensively raised on one large camel farm near Al-Kharj were 4.3% and 8.6% respectively. Fresh milk samples from 100 brucellosis seropositive camels from Riyadh and Al-Kharj were cultured on Brucella-selective media. Brucella melitensis biovars 1 and 2 were isolated and identified from 26 camels. Epidemiologically, brucellosis in camels in central Saudi Arabia appeared to be connected with B. melitensis infection of sheep and goats, and also represents a serious public health risk.

Treatment of Brucella melitensis infection in sheep and goats with oxytetracycline combined with streptomycin

Six treatment regimens using oxytetracycline (OTC) combined with streptomycin (ST) were evaluated for eliminating Brucella melitensis from 480 naturally-infected sheep and goats. Cessation of shedding Brucella from udder secretions and absence of Brucella in selected tissues at autopsy were considered criteria for successful treatment. Four regimens were equally effective in eliminating Brucella in the treated groups of sheep and goats regardless of the source of antibiotics used. These were regimen A (OTC 20 mg/kg intravenously daily for 6 weeks, combined with ST 20 mg/kg intramuscularly [i.m.] daily for 3 weeks), regimen B (long-acting [LA]-OTC 20 mg/kg i.m. every 3 days for 6 weeks, with ST 20 mg/kg i.m. every 3 days for 3 weeks), regimens D and E (LA-OTC 28 mg/kg i.m. every 3 days for 6 weeks, with ST 20 mg/kg i.m. every 3 days for 3 weeks). However, regimen C (LA-OTC 20 mg/kg i.m. every 3 days for 6 weeks, with ST 20 mg/kg i.m. every 3 days for 3 weeks) eliminated Brucella in only 75 of 80 (94%) sheep and goats. Regimen F (LA-OTC 25 mg/kg i.m. every 2 days for 4 weeks, combined with ST 20 mg/kg i.m. every 2 days for 2 weeks) was the most practical, effective and least expensive regimen for eliminating Brucella in the 80 treated sheep and goats. Brucella melitensis biovar 2 was repeatedly isolated from the mammary secretions of all sheep and goats before treatment. It was also isolated repeatedly from the udder secretions of all non-treated control animals and from selected tissue specimens collected from the controls at necropsy.

Isolation of Brucella melitensis from aborting ruminants in Jordan

Thirty-four isolates (16.5 per cent) of Brucella melitensis were cultured from 206 samples from aborted, still-born or weak full-term animals and vaginal swabs from aborted animals. Twenty-six of 31 isolates from sheep were B. melitensis biovar 3. Two isolates were biovar 1 and one of these was the vaccine strain Rev 1. The three remaining isolates were from vaginal swabs and were not biotyped since B. melitensis biovar 3 had been isolated from the aborted fetuses. One of two isolates from cattle and one isolate from a goat were biovar 1. The remaining cattle isolate was biovar 3.